背景:在妊娠和分娩期间,情感生育意向和夫妻交流是关键,同时尽量减少生殖胁迫。受孕是生殖健康(RH)权利的组成部分,可以被视为生育决策,家庭福祉和国家人口的人口红利和构成。然而,在包括埃塞俄比亚在内的低收入和中等收入国家,男性的统治地位在文化上得到了建构和社会认可,男性在每一个决策过程中都处于领先地位。在上述背景下,女性的声音不太可能被听到,因此,这项研究旨在确定女性的情绪生育准备水平及其相关因素。这一发现为从事生殖和妇女健康工作的该部和发展伙伴提供了可行的证据,以便作为一个行动点,在生殖健康权利方面赋予妇女权力,以控制其生育能力。
方法:将社区和设施数据与国家代表性联系起来,来自2020年埃塞俄比亚除提格雷地区外的绩效监测行动(PMA埃塞俄比亚)调查。该分析中包括了2,069名目前和/或最近使用避孕药的育龄妇女,她们目前已婚/作为伴侣生活在一起。计算频率来描述研究参与者的特征。采用广义有序物流回归模型来确定怀孕后女性生育意愿分层变化的相关性。结果以百分比和比值比的形式呈现,置信区间为95%。使用0.25的p值选择候选变量。在P值为0.05时宣布有统计学意义。
结果:女性感到不幸福的情绪生育意向比例为48.73%(95CI:46.21%,51.23%)。相反,22.88%,11.36%和17.03%的人表示他们感到快乐,非常快乐和复杂的感觉。年龄的增长,结婚10年及以上,使用避孕药具的决策者的类型被发现在更高级别的类别中增加了女性情绪生育意愿的几率(AOR:95%CI:6.75(3.11,14.62)倍,在35至49岁的老年女性中,(AOR:95%CI:结婚时间在10年或以上的女性高3.79(1.72,8.31)倍;对于避孕药具的使用仅由医疗保健决定的女性高1.83(1.03,3.24)倍。较高的出生顺序将女性在较高水平类别中的情感生育意愿的累积几率对称地降低了86%(AOR:95%CI:0.14(0.07,0.29)。想要生育更多孩子并且最近的设施提供了5种或更多方法的女性,其处于较高水平的女性情绪生育意愿类别的可能性增加,在累积logit中存在不成比例的关联。因此,最近的医疗机构提供5种或更多种方法的女性有49%(AOR:95CI:1.49(1.01,2.19),与情绪生育意向中的非常/排序不满意类别相比,处于混合或快乐类别的可能性增加,而在较高的累积logit:1.34(0.87,2.10)时,方法的数量与情绪生育意向没有显著关联:那些想要多生一个孩子的人,在混合或快乐类别中的几率比在不快乐类别中的高3.16(2.28,4.36)。Further,在较高的情感生育意向类别中,这种趋势甚至更强:4.83(3.23,7.23)。
结论:近二分之一的女性报告说不快乐,而17.03%的女性感到混合情绪,通过确保女性生殖和经济赋权来提高女性对生育能力的控制,呼吁有意和间隔怀孕。促进预期怀孕和间隔怀孕的活动和努力;在最近的保健设施中多样化获得避孕方法可能会改善妇女的情感生育意愿;以及使妇女也能够决定避孕方法的活动。卫生保健提供者决定妇女当前/最近使用避孕药具的发现要求开展活动以提高避孕药具使用咨询的质量,以使妇女能够自己决定其避孕药具的使用,同时在附近的医疗机构中获得多样化的方法为妇女创造了机会获得他们喜欢使用的方法并使他们情绪良好。希望这些活动使妇女能够计划生育,从而增加她们的情感福祉。这些活动和干预措施需要跨区域定制,并且需要对年龄敏感。
BACKGROUND: Emotional fertility intention and couples communication are key during pregnancy and childbirth with simultaneous minimization of reproductive coercion. Intention to conceive is an integral part of the reproductive health (RH) right and can be considered as decision making on fertility, family wellbeing and the country\'s population demographic dividend and composition. However, in low and middle income countries including Ethiopia where males dominance is culturally constructed and socially accepted, males took the lead in every decision making process. In the aforementioned context, women are less likely for their voices to be heard, hence, this study aimed at determining the level of womens´ emotional fertility readiness and its correlates. The finding provided actionable evidence for the ministry and developmental partners working on reproductive and womens´ health so as to be used as an action point to empower women in terms of their reproductive health right to have control over their fertility.
METHODS: Linked community and facility data with nationally representation from Performance Monitoring for Action (PMA Ethiopia) 2020 Survey Ethiopia except Tigray Region were used for this study. A total of 2,069 current and/or recent contraceptive user women of child bearing age who are currently married/living together as a partner were included in this analysis. Frequency was computed to describe the study participant\'s characteristics. Generalized Ordered logistics regression modeling was employed to identify correlates of the hierarchical variation in women fertility intention if they became pregnant. Results were presented in the form of percentages and odds ratio with 95% Confidence Intervals. Candidate variables were selected using p-value of 0.25. Statistical significance was declared at p-value of 0.05.
RESULTS: The proportion of womens´ emotional fertility intention of feeling unhappiness was 48.73% (95%CI: 46.21%, 51.23%). On the contrary, 22.88%, 11.36% and 17.03% of them reported that they felt sort of happy, very happy and mixed feeling. An increase in age,10 and above years marriage duration, the type of decision maker for contraceptive use were found to increase the odds of women emotional fertility intention across the higher level categories by (AOR: 95% CI: 6.75 (3.11, 14.62) times higher among elder women aged 35 to 49 years, (AOR: 95% CI: 3.79 (1.72, 8.31) times higher for women with a 10 or more years of marriage duration; and 1.83 (1.03,3.24) times higher for women whose contraceptive use was decided by the health care provide alone. A higher birth order lowered the cumulative odds of womens´ emotional fertility intention symmetrically across the higher level categories by 86% (AOR: 95% CI: 0.14 (0.07, 0.29). Women who wanted to have additional child and whose nearest facility provided 5 or more methods had an increased odds of being in the higher level categories of women emotional fertility intention with disproportional association across the cumulative logit. Accordingly, women whose nearest health facility provided 5 or more methods had an 49% (AOR: 95%CI:1.49 (1.01, 2.19) increased likelihood of being in the mixed or happy category than being very/sort of unhappy category of the emotional fertility intention while the number of methods had no significant association with emotional fertility intention at higher cumulative logit: 1.34 (0.87,2.10). Those who wanted to have an additional child had a 3.16 (2.28, 4.36) higher odds to be in the mixed or happy category than being in unhappy category. Further, this tendency was even stronger at higher categories of emotional fertility intention: 4.83 (3.23, 7.23).
CONCLUSIONS: Nearly one in two women reported being unhappy while 17.03% felt mixed emotion calling up on intended and spaced pregnancies by ensuring women reproductive and economic empowerment to empower women to have control over their fertility. Activities and efforts that promote intended and spaced pregnancies; and diversifying access to contraceptive methods in the nearest health facilities are likely to improve women emotional fertility intention; and activities that enable women to decide their contraceptive as well. The finding that health care provider decides on women current/recent contraceptive use calls for activities to improve quality of contraceptive use counseling to enable women to decide their contraceptive use by the themselves while the access of diversified methods in the nearby health facility create an opportunity for women to obtain the method they preferred to use and make them emotionally well. These activities are hoped to enable women to plan their fertility thereby increasing their emotional well-being. These activities and interventions need to be tailored across regions and need to be age sensitive.